For This Latinx Organization in San Francisco, HIV Care Is About Community

Tone Vai (left) and Kamailia Williams of Instituto Familiar de la Raza hold signs supporting the LGBTQ community during Give OUT Day 2017.
Photo courtesy of Instituto Familiar de la Raza

Instituto Familiar de la Raza owes its birth to the Chicano Movement in the San Francisco Bay Area of the 1970s. Many activists inspired by the movement turned their attention to the lack of culturally competent mental health care services for Latino/a communities in neighborhoods like the Mission District.

Health care providers at the time refused to include people of color in conversations dealing with their health and strongly followed a "one size fits all" model that did not take into account the lived experiences of the families living in the Mission. This lack of accessible and non-biased health care providers led trailblazers to begin the first integrated community-based clinic in San Francisco to incorporate holistic mental health, which looks not just at the individual, but the Latinx family unit as a whole.

In 1981, a rare pneumonia was discovered in five gay men in Los Angeles, which would mark the beginning of our knowledge of the AIDS epidemic. Just three years prior in 1978, Instituto Familiar de la Raza (IFR) opened with only one paid staff member and dozens of committed volunteers. Funded with just one grant, they began providing health services in San Francisco. By 1985 when they started HIV services, San Francisco was devastated by the HIV epidemic. After 40 years of serving families of color in San Francisco, the organization prides itself on having expanded to 105 staff members in five locations -- not including their satellite offices in schools, which play a holistic role in caring for youth by including teachers and parents in their health.

La Cultura Cura (The Culture Cures) is one of the offices located in the Excelsior District, which is densely populated with Central Americans who migrated to the area in the '80s and '90s. The organization has other sites located south of San Francisco but their main location (and their site specializing in HIV care) is in the Mission. Called, Sí a La Vida (Yes to Life), this site was strategically located in an area that made it accessible for people to seek HIV services in the early days of the epidemic. But due to skyrocketing rents, maintaining services has been a challenge.

"We almost lost our HIV site," said Rafa Velazquez, program director with IFR. "Thankfully, we have an incredible executive director who made some negotiations and was able to secure our rent for at least another five years."

This rise in rent is a result of the tech boom that has tripled housing rates in the neighborhood. The rising cost of real estate impacts commercial real estate, where nonprofit agencies that serve communities of color have to compete with tech companies as renters, which means they are likely to be as "unstably housed" as the communities they serve.

According to a 2016 Nonprofit Displacement Report from Northern California Grantmakers, commercial rent prices for office spaces increased 122% over five years. Nearly two-thirds of respondents said they would have to make a decision about moving offices due to rent costs in the next five years.

In the San Francisco Bay Area, the median home price has almost tripled in the past 10 years. This impacts not just home buyers -- the price increase is passed down to renters as well.

Claudia Y. Cabrera-Lara, the program manager for Sí a La Vida at IFR, knows this all too well. She has been working with IFR since 2001. She migrated to the U.S. for her safety. As a trans woman coming from Guatemala, she knew that her only option was to leave Guatemala. Claudia dedicates her time to helping trans women gain access to services in San Francisco.

"These techies are creating the problem," she said. "They are the reason why rent has spiked and why trans women in San Francisco are being displaced. When I first came to this city, the culture was completely different. People of color are being pushed out. This affects all of us."

The city, long before the Trump administration, had implemented a plan to end the HIV epidemic (they call it "getting to zero"). And that plan has had some success in reducing new HIV diagnoses in the city, but as fewer white gay men are contracting HIV and more people living with HIV become undetectable, the disparities become even greater for everyone else. According to 2017 data, trans women, black and Latinx people, people under age 50, homeless people, and injection drug users living with HIV were all less likely to be virally suppressed in San Francisco. And as Cabrera-Lara pointed out, housing instability in the Bay Area among all of these groups is one major factor in reduced health outcomes for people living with HIV.

Despite all these obstacles, IFR is doing their best to move forward with a unique model in public health that frames one's individual health in the context of the family, community, culture, and in terms of social justice. This, based on the Mayan concept of In Lak'ech ("You are my other me"), means that both patient and provider are working to be in a place where they are healthy and prospering.

Some of these strategies used by IFR aren't just about their approach to medical care in the Western sense. They're also about bringing the community together through cultural events like pageants and balls.

For 28 years, IFR has celebrated their "Miss and Mr. Safe Latino" pageant. Miss and Mr. Safe Latino was first hosted at Esta Noche -- one of San Francisco's first Latinx LGBT bars. Judges for the pageant are made up of community leaders, who score the nine competitors in several categories with the over-arching theme of community safety and health for all. The winners of the pageant must pledge to work toward a safe and healthy environment for members of the LGBT community in San Francisco. This year's pageant is happening June 27, during Pride weekend.

Despite the struggles many people in San Francisco face to stay healthy, and to just stay in their homes and communities, people will still come together as a community committed to a vision of health and wellness that's defined by the body, the family, and the community.